The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement: An Empirical Phenomenological Study ...
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PTJ: Physical Therapy & Rehabilitation Journal | Physical Therapy, 2021;101:1–12
https://doi.org/10.1093/ptj/pzab117
Advance access publication date May 5, 2021
Original Research
The Meaning of Sedentary Behavior as Experienced by
People in the Transition From Working Life to Retirement:
An Empirical Phenomenological Study
Caroline Eklund, PT, PhD 1 , Magnus L. Elfström, PhD, Lic Psychologist 2,
Petra von Heideken Wågert, PT, PhD 1 , Anne Söderlund, PT, PhD 1 ,
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Catharina Gustavsson, PT, PhD 3 ,4 ,5 , Sara Cederbom, PT, PhD 6 ,
Charlotta Thunborg, PT, PhD 7 , Helena Lööf, PhD, RN 8 ,9
1 Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
2 Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
3 Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
4 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
5 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
6 Centre for Development, Social Welfare and Care, Västmanland County Council, Västerås, Sweden
7 Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute,
Stockholm, Sweden
8 Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
9 Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
Abstract
Objective. Sedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown
to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in
daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in
relation to the transition from working life to retirement as experienced by persons in retirement.
Methods. The study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were
conducted with participants aged 64 to 75 years. Data were analyzed using the empirical phenomenological psychological
method.
Results. The participants described that voluntary sedentary time was positively related to general health and well-being,
whereas involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural
when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal
and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants
strived to find a balance between physical activity and sedentary time. The variations in the participants’ descriptions formed
3 typologies: in light of meaningful SB, in the shadow of involuntary SB, and a dual process—postponing SB with physical
activity.
Conclusion. Increased SB was perceived as natural when aging but something that may be postponed by conscious choices.
SB was perceived as associated with health, rest, and recovery but also with the risk of deteriorating health.
Impact. This knowledge of the experienced meaning of SB could guide the design of health promotion interventions and
may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.
Lay Summary. This study reveals how persons in retirement describe sedentary behavior as something healthy but also as
unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.
Keywords: Healthy Aging, Lifestyle, Phenomenology, Physical Activity, Sedentary
Received: June 1, 2020. Revised: February 15, 2021. Accepted: April 11, 2021
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.2 The Meaning of Sedentary Behavior in Retirement
Introduction the meaning and significance of experiences. Taking departure
The population of older adults is increasing worldwide.1 The from the life-world perspective, the phenomenon is insepara-
physiological changes the aging body undergoes contribute bly connected to the individual who experiences it, and the
to an increased risk for many diseases and also a decline in description is from a first-person point of view; no experience
general physical capacity, leading to the aging body being can be dismissed as false.
more vulnerable to health problems.1 This may contribute to Husserl18 stated that people share perceptions of a phe-
ill health and a heavier load on health care systems. nomenon and that this intersubjectivity is essential for the liv-
Sedentary behavior (SB) is defined as a mean of >6 hours ing world (ie, the world that we share), and a phenomenon can
of sitting or lying down daily, excluding during the nighttime. have common “denominators” for different people.18 The use
SB is also defined as energy expenditure 4 h/d and had a low physical activity level had an increased the study instructions. Exclusion criteria were self-reported
risk of dying earlier.9 serious disease (eg, diagnosed dementia, severe musculoskele-
An earlier study indicated that recently retired older adults tal disease that would hinder the participants being physically
might be unfamiliar with the concept of SB or its negative active such as hemiplegia, chronic heart failure, severe COPD,
health implications.10 Moreover, a number of factors might or severe depression), severe loss of vision or communicative
contribute to SB: physical limitations11 (eg, perceived pain12 ) ability, and/or working 8 h/wk or more.
as well as psychosocial factors, such as a lack of motivation,11 In Sweden, retirement organizations are non-governmental
a lack of energy, social pressure to rest in older age, agist organizations consisting of retired persons who look after
stereotyping,12 and environmental factors12 (eg, availability the interests of persons in retirement. They also provide a
of community resources,11,13 physical infrastructure13 such platform for social events. A regional retirement organization
as access to attractive facilities for physical activity,14 and cul- in the middle of Sweden was visited by the first author (C.E.),
tural differences11 ). Older adults may see their bodies as vul- who presented the study to potential participants. Interested
nerable and feel that they, as older adults, are allowed a seden- persons were prompted to contact the first author for more
tary lifestyle.15 For many older adults, engagement in non- information if interested to participate. One participant con-
SB through structured physical activity is not appealing.16,17 tacted the research team after reading about the study in a
This is often related to a reluctance to exercise because they do local newspaper. No one declined participation in the study
not regard themselves as “sporty.”17 Enjoyment, socialization, after receiving personal information about the study from the
and a sense of achievement are crucial for older adults to researchers.
take part in non-sedentary activities.15 Additionally, being The final sample comprised 14 participants (Table 1),
physically active before retirement might also contribute to representing a variety of sociodemographic and socioeco-
continued regular physical activity in retirment.15 However, nomic aspects, SB, and living conditions. Eight persons were
shortcomings of previous studies are lack of analytical trans- recruited after being referred by another participant. One of
parency,12 a focus on socially active persons,11 and a focus on the persons recruited for pilot interviews was also included
needs regarding physical activity rather than on SB.10 in the study. After participants were verified to satisfy the
It is important to understand older adults’ perspective on SB inclusion and exclusion criteria, all participants received oral
because interventions aiming at promoting physical activity and written information regarding the study according to
and decreasing SB are not informed by older adults’ perspec- ethical guidelines, including their rights, and provided written
tive and might therefore be perceived as less purposeful among informed consent before the interview started.
the older adults,15 leading to low adherence. Understanding
the meaning of SB in persons transitioning from working
life to retirement can guide the design of health promotion Pilot Study
interventions. Therefore, the aim was to gain a deeper under- The interview guide was tested to determine whether it was
standing of SB in relation to the transition from working life possible to address the questions among both health care
to retirement, as experienced by persons in retirement. professionals (n = 4) and potential participants (n = 2), which
constituted a preliminary study according to Aspers.22
Pilot testing among potential participants were conducted
Methods by the first author (C.E.) and among health care professionals
Design by the last author (H.L.). The health care professionals were 2
This study was grounded in an empirical phenomenological females, 1 registered nurse and 1 registered physical therapist,
life-world perspective.18–20 Phenomenology18,20 focuses on and 2 male medical doctors working within rheumatology andEklund et al 3
medicine units. The number of years of professional experi-
ence ranged from 10 to 40 years. The potential participants
were persons who fit the study inclusion and exclusion criteria
Retirement organization
Retirement organization
Retirement organization
Recruitment and were chosen by the first author. One man and 1 woman
representing different occupations, both active and sedentary,
were recruited. Health care professionals were acquaintances
of the last author.
Newspaper
Pilot study
The interview guide was confirmed to have a high level
Snowball
Snowball
Snowball
Snowball
Snowball
Snowball
Snowball
Snowball
Snowball
of usefulness. Questions 1 and 4.1 were added during the
pilot interviews and to the final interview guide. One of the
participants in the pilot study agreed to be included in the
final sample. After the participant signed informed consent,
the interview was thus included in the analysis. The interview
Retired (y)
Age When
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questions were not revised after that interview.
55
65
65
65
67
67
63
62
65
60
63
62
58
64
Research Team
All authors except the second and the last author are physical
therapists. The second author is a licensed clinical psycholo-
gist, and the last author is a registered nurse. All authors have
Married
Married
Married
Married
Married
Married
Married
Married
Married
Married
Status
Civil
Alone
Alone
Alone
Alone a PhD. The physical therapists have different clinical back-
grounds and research areas such as pain management, geri-
atrics/gerontology, physical activity, health promotion, behav-
ioral medicine, and lifestyle-related behaviors. The clinical
background of all authors is varied: geriatrics, rheumatology,
Active/Sedentary
respiration, musculoskeletal, neurology, pain, and more. Years
Occupation as
Sedentary/active
Sedentary/active
Sedentary/active
Sedentary/active
Former/Last
Physically
of research experience varies from 8 to 25 years within the
author group. All authors have experience with qualitative
Sedentary
Sedentary
Sedentary
Sedentary
Sedentary
Sedentary
Sedentary
methods and interview methodology. The first author has
Active
Active
Active
experience in interview methodology from research and also
clinical contexts. The last author has performed several studies
with a phenomenological approach using interviews.
Conditions
Data Collection
Apartment/
Apartment
Apartment
Apartment
Apartment
Apartment
Apartment
Apartment
Living
Data were collected through individual in-depth face-to-face
summer
House
House
House
House
House
House
house
interviews using a semi-structured interview guide focusing on
SB (Fig. 1). The participants were asked to select a comfort-
able place for the interview, and the selection of the location
was determined jointly after that. All interviews were con-
ducted in central Sweden at the participant’s home except 2,
6 (8 during winter)
winter–summer)
Sedentary Time
6 (very unsure)
where the participants preferred to come to the university. The
Self-Reported
8–10 (differs
5–6 (unsure)
Per Day (h)
interview questions were designed to stimulate narratives and
6–7
5–6
3–4
3–4
15
10
to attain representation of the diversity of lived experiences
8
8
4
6
of the phenomenon. The interviews aimed to investigate what
being sedentary means from the participant’s perspective by
prompting the participants to describe situations in daily life
in relation to sedentary time and behavior. Interviews were
performed by the first author. All participants were unfamiliar
with the first author performing the interviews except for the
Sex
M
M
M
M
M
M
person recruited for the pilot interview and included in the
F
F
F
F
F
F
F
F
Table 1. Participants’ Characteristics
present study as well as 1 participant who had worked within
the same organization as the first author 10 years earlier.
The interviews were performed over 6 months during 2019.
The interviews lasted from 24 to 54 minutes (mean, 36 min-
Age (y)
utes). Field notes were taken regarding the atmosphere during
71
75
75
68
68
71
67
68
72
72
74
72
68
64
the interviews as well as for time, date, and location of
the interviews. After 10 interviews, the descriptions of the
phenomena in focus started to be repeated, and no new
Pseudonym
Participant
descriptions were added during the last 4 interviews. This
Kenneth
Barbara
Cheryl
Carole
Walter
Henry
was also ensured during the analysis process because every
Karen
Sylvia
Mary
Anna
Peter
John
Judy
Paul
interview constituted 1 synopsis and thus 1 unit.4 The Meaning of Sedentary Behavior in Retirement
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Figure 1. Interview guide.
Data Analysis phenomenological and hermeneutical method. EPP was
The interviews were audio-recorded and transcribed verbatim. chosen as a method for analyzing data to learn from the
Transcriptions were performed by the first author. Data informants’ experiences about SB. The analysis followed the
were interpreted by using the empirical phenomenologi- 5 steps (Tab. 2) described by Karlsson.23 The first (C.E.) and
cal psychological (EPP) method,23 which is a combined last (H.L.) author performed the analysis.Eklund et al 5
Table 2. The Five Steps of the Empirical Phenomenological Psychological Method as Described by Karlsson23 (1993) and Definition of Epoché
Analysis Steps Content
1) Getting familiar with data Interviews were listened to and transcribed Transcribed interviews were read through several times to
grasp the whole
2) Meaning units Meaning units (MUs) were identified and researchers searched for shifts in meaning regarding
phenomenon in focus of present study
3) Eidetic induction Eidetic interpretation of MUs was performed based on everyday language used by participants as they
described phenomenon to find characteristics in the narratives;
This means that participants’ expressions were translated into a psychological meaning
4) Situated contexture Each interview text was summarized into a synopsis; the 14 synopses were based on MUs that had
gone through eidetic induction into a new “whole” to describe phenomenon as a lived experience and
what phenomenon is
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5) Results in general characteristics First, a general structure and general characteristics were searched for by comparing and identifying
and typologies similarities among 14 synopses. General structure describes what the phenomenon is, whereas general
characteristics are essentialities commonly expressed throughout the narratives;
Second, similarities were synthesized into general characteristics and formed 3 typologies representing
variations in how phenomenon was described in data
Epoché Epoché means to adopt a reflective and critical attitude and bridle preunderstanding and set aside
assumptions and beliefs about phenomenon in focus; epoché was a crucial part of every step of analysis
As noted in step 5, the variations of the phenomenon were empirical approach, must be as open as possible in rela-
interpreted in terms of typological structures. Typological tion to the original experience of the phenomenon described
structures are meanings of the phenomenon described by the by the participants. To bridle the pre-understandings in the
participants in relation to the aim. Typological structures are researchers performing the analysis (the first and the last
considered essential to understanding the “how” in how the author), systematic reflection was used to determine the essen-
phenomenon was experienced and describe the different ways tial properties and structures of human experience (in relation
in which the phenomenon appeared in the data. Typologies to SB). The focus was to describe the meaning attributions, as
represent the variations in how the phenomenon is experi- searching for a description of the universal essence, of the phe-
enced in order to understand the essence of the phenomenon. nomenon. This systematic reflection enhances the credibility
The variation can be found within an individual’s expression, and also the confirmability of the study.
meaning that 1 participant can be represented in more than To further ensure confirmability during the analysis, the
1 typology. The first and last authors discussed how the first and the last authors independently worked with the mate-
variations in the descriptions by the participants could be rial to see if there was a consensus for how the eidetic induc-
understood and formed the 3 typologies. Typologies can be tion formed the synopsis for each individual interview text.
understood in relation to other qualitative methods as major The final typologies were critically reviewed by all authors
themes. The last author with many years of experience with and contributed to the credibility of the study.
the EPP method drafted the text for the 3 typologies. The first To enhance both dependability and transferability, the
and last authors discussed the 3 drafted typologies on several research process, the study population, and context where
occasions, and whenever uncertainties occurred, the first and the study took place have been described as accurately as
last authors went back to the original transcribed interviews possible without compromising the confidentiality of the
to confirm the interpretation of the text, as done in step 4. participants.
Establishing Trustworthiness Role of the Funding Source
Lincoln and Guba have described 4 aspects of trustworthiness The funders played no role in the design, conduct, or reporting
in qualitative studies: credibility (confidence in the “truth” of this study.
of the findings), dependability (refers to the findings being
consistent and stable over time and conditions, and also
considers the quality of the researcher and the training of Results
the interviewer), confirmability (a degree of neutrality or the A number of general characteristics were found that emerged
extent to which the findings of a study are shaped by the study from the participants’ descriptions of how self-elected and
participants and not researcher bias, motivation, or interest), voluntary SB after retirement could be related to health.
and transferability (shows that the findings are applicable in However, involuntary SB was also perceived as related to
other contexts).24 ill health. SB was described as a dynamic and changing
Husserl’s phenomenology starts with reflection or epoché. process to find a balance between being sedentary versus
Epoché means “suspension of judgment” or “withholding of being physically active and performing exercise in everyday
assent” and is important regarding credibility. This demands life after retirement.
from the researchers a reflective and critical attitude in which Being sedentary was perceived as a behavior that threatens
one “slows down” the process of understanding to see the health and thus something to avoid. Furthermore, being
phenomenon in a new way.25 The researcher, in such an sedentary was also perceived as healthy and existentially6 The Meaning of Sedentary Behavior in Retirement
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Figure 2. The research question, general characteristics, and the 3 typologies identified illustrated with quotations from the participants.
meaningful after retirement, and attitudes toward being Participants who have had a physically demanding occupation
sedentary had changed for several participants after retire- described how the aging body was tired. They expressed
ment. A majority of the participants described how they an increase in pain, aches, or joint wear and that an older
consciously made choices to delay increased SB with routines body that carries pains and ailments also needs more rest. SB
for activity and exercise after retirement. can thus be understood as a form of escape or a moment’s
Three typologies were formed to capture the differences sanctuary from pain or a lack of energy. The reaction towards
in the descriptions (Fig. 2): in light of meaningful SB; in more SB may derive from the body’s signals, driving attention
the shadow of the involuntary SB; and a dual process— to the needs for rest and recovery and to alleviate bodily
postponing SB with physical activity. The typologies are illus- symptoms that have become increasingly common in retire-
trated by quotations by the participants. ment. The body was described as more vulnerable to long-
term sedentary time than it had been earlier in life as well as
more vulnerable to excessive exercise or activity. When aging,
Typology I: In Light of Meaningful Sedentary physiological signals and bodily vulnerabilities (eg, energy
Behavior in Retirement shortages and decreased fitness) are more clearly signaled, and
it was described as important to listen to the different signals.
The participants describe that being sedentary gained a new
Furthermore, this reactive process may also go in the opposite
meaning after retirement. Retirement was comforting for the
direction, as prolonged sedentary time was also interrupted
body; it was a time for rest, recovery, and a slower pace in
by restlessness and increased stiffness or more pain and aches.
life, which contributed to increased awareness of harmony
Thus, it was difficult to be sedentary for too long at a time.
and pleasure. Beliefs were expressed regarding the aging body
One needs to move to maintain body circulation or to avoid
and how it should be handled. Life was described as good
falling asleep.
during retirement and was viewed as full-time vacation. The
The participants described a positive aspect in their freedom
participants expressed an acceptance of the increased need for
to choose everyday activities that they found important or
sedentary time over time as a natural process of aging. They
enjoyable, often activities that there had been no time for ear-
expressed that the body and the soul deserve rest and recovery
lier in life, which included sedentary activities such as playing
in retirement:
bridge, having coffee, and photo editing. This self-elected and
Yes (answering the question about becoming retired), that’s voluntary sedentary time was described as meaningful and
what I think. It was a full-time holiday, you could say. And gave instant pleasure but was also described as un-reflected
you can do things in your own pace, everything you did and that it just happened. Several activities performed while
before. Earlier you may have done 5 things every day. You sitting are described by the participants as fun or intellectually
don’t have to do that today. Today, you do 2 things maybe, stimulating, such as solving crosswords, reading an exciting
that you find important. – John book, or having time for reflection, and were related to health.Eklund et al 7
Usually, I read, solve crosswords, do sudoku. And my ability or not being able to do things in the same way as before
husband and I listen to audiobooks together. Watching was frustrating.
TV. And I sew some. I don’t know if that’s what you call
sedentary? [ . . . ] It feels good many times. [ . . . ] Yes, it is Then, I got some problems with a knee which made me quit
really relaxing and nice to do it [being sedentary]. [ . . . ] [certain activities], and then there is some problems like not
When I am sitting and it feels good, and I can enjoy it. [ . . . ] being able to move as much. And then I got into another
I think that I am worth it, to sit during that moment I am pattern in life. I thought it was very disturbing. To not be
sitting. –Anna able to walk properly and such, and it hurt more when one
walked and . . . and . . . it was kind of disturbing. –Peter
Within this typology, however, the participants expressed an
awareness of the importance of supplementing sedentary time SB can be understood as a result of loneliness and negative
with physical activity. This knowledge of the health benefits of emotional triggers such as reduced zest for life, which was
movement was described in relation to the physiological gains described as contributing to unhealthy sedentary time. This
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of physical exercise. Healthy sedentary time is experienced in kind of SB can also result in a negative spiral, leading to more
relation to being at rest after physical activity, which is good SB. SB itself was also described as a risk factor for being
for the aging body. Above all, the body needs to be activated to more sedentary. Unhealthy SB was described as not having
successfully perform everyday chores or reduce stiffness and something to do or waiting for something, such as a way of
pain. The participants described that there are often things killing time, unreflective and dull SB, or a quiescent SB, which
to do, such as taking care of a home and house. Furthermore, may have arisen or escalated in retirement. Sometimes SB was
they described family and friends as playing an important role also a result of being too comfortable or not having had the
in naturally decreasing sedentary time, even if many social character or strength to start again with physical exercise after
events are sedentary in nature. The choice of activity was injury. A fear avoidance of physical activity was described
often made based on seasonal activities, such as playing golf in terms of uncertainty of what was allowed or good to do
during the summer. It was emphasized that it was easier to be following physical injury. SB was furthermore described as
physically active during summer, while during winter, it was a reflection of one’s former identity in life. To not consider
easier to become more sedentary. oneself a sporty person or to not engage in or enjoy physical
exercise earlier in life can be understood as maintaining SB
after retirement.
Typology II: In the Shadow of Involuntary
Sedentary Behavior I have never been some kind of sporty person. Never. I don’t
Within this typology, the participants described how SB was even like sports on TV. But I don’t want to be any kind of
related to times in life in which the participants struggled for hibernated jock who absolutely has to go to a gym. I don’t
some reason. Unhealthy SB was described as an imbalance in go to a gym whatsoever because it smells terrible. I have
relation to physical activity that led to poor health. tried a couple of times but it smells bad. I don’t want to do
Loneliness and social isolation contributed to SB and was that. –Mary
also described as leading to withdrawal from physical activ-
ities. Loneliness was described as making it more difficult Trying new activities, even if one wanted to, was described
to find activities to engage in, both when active and when as difficult without social support but also with respect to
sedentary. SB was described to increase with reduced zest for various personal factors, for example, a lack of enjoyment of
life and boredom. An experience of being mentally out of physical exercise or illness or injury. If support was available,
balance occurred with prolonged and unhealthy SB, especially it was considered to facilitate greater success in reducing
while in front of the computer or TV. SB. Without support in breaking the patterns of SB over
Being sedentary in solitude was described as a meaningless time, success might become problematic. It was described as
life. Being alone and sedentary, with a low level of intellectual frightening to develop a life pattern in which SB increased,
stimuli, was described as threatening to one’s well-being and because it was considered to threaten well-being in retirement
health. Being lonely with no planned activities could also lead by creating feelings of meaninglessness, lethargy or tiredness,
to anxiety. Participants in this typology described a longing and killing time with nothing to do as well as to contribute
to find like-minded people with whom they could socialize. to more bodily pain and stiffness and decreased physical
Socialization could contribute to decreased SB and loneliness. status. Everyday routines and a supportive social environment
In parallel, the participants described a longing for support to were described as central to disrupting patterns of unhealthy
be more active and involved, especially in an accepting social extended SB (quotation II.C).
community, having family or friends to visit or routines that
included physical activity at home, because environmental dis- Yes, I live a very sedentary life. And it makes it boring. I
tractions play a major role in interrupting SB. Involuntary SB would like to go out more, I would above all want to have
was associated with ill health and was described as something more friends that I could call because I feel anxiety when I
that increased in periods after retirement. Reduced energy am sitting here, and nothing happens. –Mary
and a lack of strength caused by illness or injury could lead
to a lack of motivation for physical activity, thus leading to
SB, more pain and stiffness, and less energy. Furthermore,
the aging body was perceived as more vulnerable to strain. Typology III: A Dual Process–Postponing Sedentary
Unforeseen events, such as injuries or recurring illnesses, Behavior With Physical Activity
interrupted the former routines of daily living and created new The participants in this typology described how SB was noth-
patterns in life with undesired SB. Not having the physical ing that they longed for in retirement and not something8 The Meaning of Sedentary Behavior in Retirement
of value in itself. In contrast, good health, physical activity, There were few thoughts or major concerns about the future,
and everyday life activities were the main areas of focus, but the participants expressed an awareness that involuntary
giving meaning to life in retirement. It was described as SB may increase when aging, but the participants were not
important to plan projects and activities so that the body ready to become sedentary yet. The participants in this typol-
remained physically active throughout the day in relation to ogy described themselves as very active in everyday life and
SB. Having routines was expressed as critical in interrupting had many plans. The participants described how SB could
sedentary time. The positive attitude the participants had be delayed in retirement through various projects, such as
regarding physical activity before retirement and earlier in life renovating the home, helping relatives with various tasks, and
affected SB in retirement. Persons engaged in regular physical exercising. Additionally, retirement was described as a phase
exercise or who were active in everyday life before retirement in life when one can make new choices for a more active life
brought that behavior with them into retirement. In that way, (quotation III.C).
the participants described that life continues the way it did
before. It was perceived as important not to slow down too No, I can’t say that [about being sedentary], I am far from
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much in retirement and to maintain routines for physical that, depending on what you put in to being sedentary
activity and exercise. A structured daily life with things to [ . . . ]. So, it may be that I have difficulties sitting still [ . . . ].
do while physically active was desired. Sedentary time was I set the alarm to half past 7, otherwise I would not get
described as something that naturally interrupted everyday life up, [ . . . ]. And then I do a stretch program that I do every
activities and recovery after physical exercise. In this sense, morning, so to speak. And then I eat porridge and read the
being sedentary was perceived as valuable and meaningful. paper and take a cup of coffee, so let’s say an hour there.
Being active led to a need for (healthy) sedentary time. Then, I work [garden or renovating]. Then, I go out and do
Participants who had a sedentary working life tended to something or . . . and then I eat lunch . . . –Henry
describe physical exercise, for example, at a gym, as important
to staying healthy in retirement. A desire and a longing
for physical activity after retirement was described. During Discussion
periods with less physical exercise, such as after injuries or The objective of this study was to gain a deeper understand-
illnesses, the risk was to slip out of this regularity and become ing of SB in relation to the transition from working life
more (unhealthily) sedentary. When events in life interrupted to retirement as experienced by persons in retirement. The
physical activities and exercise, it was expressed as important phenomenon of SB can be understood in terms of a shifting
to make active and conscious choices, have a positive attitude duality as related to both health and ill health. SB was, to
toward exercise, and have a supportive social network to get some participants, related to health and was mostly longed
back to routines. for (typology I). In contrast, there were also participants who
The physiological benefits of exercise were expressed as described SB as related to ill health (typology II). In typology
an experience of feeling good, increased body flexibility, and III, the participants expressed how reflective and conscious
improved mental status. The participants described that dur- choices and daily routines, including physical activity and
ing periods of no physical exercise, physical health decreased exercise, may delay SB, which was perceived as a natural
and joint stiffened as a result. Also, other bodily changes process when aging.
associated with poor health became more evident. When attempting to understand a phenomenon such as SB,
it can be advantageous to explain the process to and from
And I take walks. And I go to Friskis and Svettis [gym], at the behavior. Thus, the results in this study can be interpreted
least during the half-year winter season and attend 2 classes in relation to social cognitive theory (SCT).26 For the under-
a week. And that is something I started with when I turned standing of human social behavior, SCT links personal factors,
65. [ . . . ] and I started lifting weights in the gym because behavior, and environment together in a reciprocal interac-
it was really good to go to the gym when you were retired tion.26 The participants described the process to and from SB
since you could go there before lunch when there was not a in terms of a number of personal (physical and psychological)
queue for the equipment. And I pretty much enjoyed going and environmental (social and physical) factors (Fig. 3). Both
to the gym, and it was two, three, at least 2 times a week positive and negative emotions and feelings as well as beliefs
[ . . . ]. So, it’s that and to walk, that’s what I chose. –Karen about SB as healthy or unhealthy can lead to SB as well as
to physical activity. The same goes for environmental factors
Routines for physical exercise were described as essential for that can both lead to and from SB. The key in understanding
maintaining physical exercise and a natural part of everyday SB is in what context the behavior occurs and also how the
life. Retirement was described as an opportunity to decrease individual perceives the behavior in that context as leading to
SB. The participants strived to have a meaningful life that feelings of well-being or the opposite.
included physical activity after retirement (quotation III.B). The participants in typology I expressed how SB can be a
way of escaping from the personal factor of pain, but in a
The dog, we take him for a walk every morning. We are reciprocal manner SB could also lead to bodily signals such
a whole gang, and dogs together. [ . . . ]. We are out for an as pain, restlessness, and stiffness. Other studies have shown
hour. Then you come home and you make breakfast, after that persons with long-term pain have described that physical
breakfast you do this [ . . . ]. Then, I work in the garden and activities can mediate pain reduction and be a distraction from
lite so and so, and I move the lawn and [ . . . ]. Then, I take it.27–29 This was also described by the participants in present
the dog for a walk an hour, one and a half maybe. And then study, as SB was also interrupted by restlessness and other
it is afternoon . . . –Carole bodily signals. Furthermore, long-term pain is a risk factorEklund et al 9
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Figure 3. Environmental and personal factors described by the participants related to SCT as influencing the process to and from a sedentary behavior
(SB).
for frailty in older adults.30 Frailty in older adults should be This confirms the findings in typology III in the present study.
prevented, and by decreasing SB, the risk for developing frailty Beliefs regarding the benefits and appropriateness of being
may also be reduced because there is an association between sedentary or physically active and its relationship to (ill)
SB and frailty.31 During periods of solitude or sedentary time, health influence SB and whether individuals are physically
inner bodily attention in some patients with long-term pain active. Furthermore, self-identity has been shown to influence
is often directed towards the problematic body and self29 how a sedentary lifestyle is more permissible and accepted
connecting the social environment and personal factors to the by aging persons and is something that feels good,15 con-
behavior. Solitude and SB may thus lead to a negative spiral firming the findings in typology I and explaining how the
to more SB due to reciprocal effects on each other. Previous social environment can both encourage physical activity and
studies have shown an association between depression and promote SB in older adults by expecting that. The findings
SB.32 In the present study, the participants expressed that in the systematic review15 further confirm the findings in the
being sedentary in solitude threatened well-being and health. present study in typology II regarding how the aging body
The mental health of older adults is an important aspect of is perceived to have limitations that inhibit physical activity
prolonged independent living, and its association with SB is and how fear of injury and avoidance beliefs when in pain
important to consider in interventions aiming to decrease SB. were barriers to physical activity. It has been suggested that
Thus, SB affects individual factors such as feelings of well- the approach of integrating functional exercise into daily life,
being; these factors are also affected by environmental factors rather than structured exercise programs, is a favorable option
(such as loneliness) in a reciprocal manner. Another important to reduce SB in older adults.33 Reducing SB by increasing
aspect expressed by the participants in the present study is also functional activities can be more easily implemented because
beliefs of how SB is meaningful in retirement and something they are closely aligned with the accomplishment of desired
that gives a feeling of well-being. The participants expressed daily tasks.33
that there is time for and expectations of being able to be The transition to retirement is a major life event and can be
more sedentary and give rest to the aging body when in a critical window for interventions to improve health.34 This
retirement. was described by participants who created everyday routines
A systematic review and meta-synthesis on how older adults for physical activity in retirement. The participants described
perceived the acceptability of physical activity in aging found the importance of paying attention to their new choices in
that the perception of self-identity and roles within the wider everyday life to reflect on what leads to SB and what takes
society affected the level of physical activity when aging.15 one out of it, which can be related to the concept of self-
Those who engaged in physical activity in older age did so regulation in SCT.26 One of the most important findings in
because it had formed part of their identity earlier in life.15 this study was that SB often occurred due to unreflective10 The Meaning of Sedentary Behavior in Retirement
and conscious choices, and being able to self-regulate35 was loneliness and lack of routines. This study may not have
described as a key factor in decreasing sedentary time. To be succeeded in recruiting persons in the immediate transition
able to self-regulate and develop new healthy behaviors, one from working life to retirement, which may therefore be of
must be knowledgeable of the risks of a behavior. interest in future studies.
In a clinical setting, it is important for the physical ther- The snowball sampling used may have resulted in par-
apist to identify how clients/patients perceive or experience ticipants recruiting other participants similar to themselves.
their everyday life in relation to SB in order to support Nevertheless, the participants differed regarding former occu-
clients’/patients’ health-related behavior changes. For exam- pations and living conditions. It has been shown that there
ple, when a physical therapist meets an older patient with is a difference in physical activity levels between lower and
chronic low back pain, it is important to discuss how the higher socioeconomic groups in retirement.37 In the present
patient sees themselves as being sedentary when the back pain study, participants who described heavier work tasks before
limits their activities. Positive and/or negative narratives of retirement expressed the need for recovery and to escape
SB should be encountered. If a patient describes that their from bodily pain and therefore welcomed SB compared with
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activities in everyday life are restricted due to the chronic low persons with mostly desk work. The type of work could
back pain leading to an involuntary SB, it is important that be considered to be related to socioeconomic status, but
the physical therapist can identify the involuntary SB. If the socioeconomic status alone may not explain differences in SB
patient performs activities sitting due to pain that may be in retirement among different socioeconomic groups. Earlier
possible to perform while standing, the physical therapist can studies have had low representation of men,10–12,15 and sex
contribute with insights regarding the importance to vary the heterogeneity is a strength in the present study. However,
position and reducing sedentary time by making small changes all participants were ethnic Swedes who contributed to a
in actives in everyday life. Together with the patient, the homogenic sample in that aspect, which could be a limitation
physical therapist, with their unique competences regarding regarding transferability of the study results to other groups.
pain and activities, may find alternative positions to vary This study was conducted in the middle of Sweden where the
sitting and standing and thus support the patient to reduce climate differs with the season: cold winters with snow and
the involuntary sedentary time. heat during the summer. The results in our study related to par-
Because actions taken to support behavior change are ticipants’ description of SB may therefore not be transferable
related to the understanding of a complex behavior (ie, to populations of older adults living in another climate zone.
exercise behavior), we first need to describe and understand In a phenomenological approach, the researcher must be as
the phenomenon from a life-world perspective18 to support open as possible in relation to the original experience of the
individuals to change it.36 According to the results in phenomenon as described by the participants.38 This includes
the present study, the identification regarding if the SB is ensuring credibility by moving back and forth between the
voluntary or not is of significance because clients seem to interpretations and the data by letting the researcher reflect
relate this to health and well-being. When physical therapists and refine the dimensions of the overall meaning structure.23
encounter persons in the transition from working life to To bridle the preunderstanding of the authors involved in the
retirement, SB should be addressed. Information about SB data analysis, the preunderstanding was continually discussed
and a possible negative effect on health should be offered. In and reflected on, strengthening the credibility of the present
the present study, the environment (both social and physical study. Member checks were not performed in the present
as well as the inner motivation and personal beliefs, etc) was study, which might be a limitation. Member check has been
reported as important to decrease or increase SB. Physical argued as a crucial method to improve trustworthiness of
therapists can support the clients/patients to transform qualitative studies.24 The member check process typically
the environment to give opportunities for decreasing the includes that the participants receive a copy of the findings
unhealthy SB and to find a balance between healthy SB and and annotated themes with the opportunity to reflect and
activity. Physical therapists can encourage clients/patients comment on the findings based on their own experiences.39
to seek social support for activity in their everyday life or But there is also critique towards member check as a method
transform the clients’/patients’ physical environment, for for improving trustworthiness in that sense that it can be
example, advising the client/patients to procure a height- difficult for the participants to follow because the results have
adjustable table to enable the patients/clients to perform task been synthesized, decontextualized, and abstracted from and
usually performed sitting in standing. This might be even more across individual participants to the extent that it might be
important during colder seasons when SB is more common difficult to recognize themselves or their own experience.40
according to present study. This might be even more evident in a phenomenological study
using the EPP because the level of interpretation to a higher
psychological meaning can be even more difficult to follow;
Limitations this was why member checks were not used in the present
The results did not reveal a general structure due to the study. In this study, the systematic reflections to bridle the
variations of the descriptions among the participants. This preunderstanding, the first and the last author independently
is not uncommon in phenomenological studies (see27 as an working with the analysis as well as the final typologies being
example), especially in regard to a complex phenomenon such discussed within the author group strengthen the trustworthi-
as SB, which can be experienced in multiple ways. ness of the results.
There was a large range in the time since retirement (1– The experienced meaning of SB in retirement can be a key
13 years) among the participants. It is possible that the large in developing an understanding of health and ill health among
range in time since retirement may have influenced the results, adults after the transition from working life to retirement.
particularly regarding loneliness and establishing routines Additionally, a deeper understanding of the meaning of SB
in everyday life. Longer time since retirement may increase in this group may inform interventions for reducing SB toEklund et al 11
be more acceptable. This study fills a gap regarding what from more than 1 million men and women. Lancet. 2016;388:
SB means in retirement, which may be helpful in targeting 1302–1310.
those in need of support in decreasing SB and individualizing 10. Van Dyck D, Mertens L, Cardon G, De Cocker K, De Bourdeaud-
interventions to decrease SB for persons in retirement. Future huij I. Opinions toward physical activity, sedentary behavior, and
research should focus on how to encourage decreased SB interventions to stimulate active living during early retirement:
a qualitative study in recently retired adults. J Aging Phys Act.
among those in transition from working life to retirement.
2017;25:277–286.
11. McEwan T, Tam-Seto L, Dogra S. Perceptions of sedentary behav-
ior among socially engaged older adults. Gerontologist. 2017;57:
Author Contributions 735–744.
Concept/idea/research design: C. Eklund, M.L. Elfström, 12. Chastin SFM, Fitzpatrick N, Andrews M, DiCroce N. Determi-
P. von Heideken Wågert, A. Söderlund, C. Gustavsson, S. Cederbom, nants of sedentary behavior, motivation, barriers and strategies to
C. Thunborg, H. Lööf reduce sitting time in older women: a qualitative investigation. Int
Writing: C. Eklund, M. L. Elfström, P. von Heideken Wågert, J Environ Res Public Health. 2014;11:773–791.
A. Söderlund, C. Gustavsson, C. Thunborg, H. Lööf 13. McGowan LJ, Powell R, French DP. How acceptable is reducing
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Data collection: C. Eklund sedentary behavior to older adults? Perceptions and experiences
Data analysis: C. Eklund, M. L. Elfström P. von Heideken Wågert, across diverse socioeconomic areas. J Aging Phys Act. 2019;27:
A. Söderlund, C. Gustavsson, C. Thunborg, H. Lööf 642–652.
Project management: A. Söderlund, H. Lööf 14. Schutzer KA, Graves S. Barriers and motivations to exercise in
Consultation (including review of manuscript before submitting): older adults. Prev Med. 2004;39:1056–1061.
M.L. Elfström, P. von Heideken Wågert, C. Gustavsson, S. Cederbom, 15. McGowan LJ, Devereux-Fitzgerald A, Powell R, French DP. How
C. Thunborg, H. Lööf acceptable do older adults find the concept of being physically
active? A systematic review and meta-synthesis. Int Rev Sport
Exerc Psychol. 2017;11:1–24.
Funding 16. Burton NW, Khan A, Brown WJ. How, where and with whom?
This study was funded by a grant from the School of Health, Care Physical activity context preferences of three adult groups at risk
and Social Welfare at Mälardalen University, in Västerås/Eskilstuna, of inactivity. Br J Sports Med. 2012;46:1125–1131.
Sweden. 17. Costello E, Kafchinski M, Vrazel J, Sullivan P. Motivators, barriers
and beliefs regarding physical activity in the older adult population.
J Geriatr Phys Ther. 2011;34:138–147.
Disclosures 18. Husserl E. General Introduction to Pure Phenomenology. New
York, NY, USA: Collier Books; 1962.
The authors completed the ICMJE Form for Disclosure of Potential
19. Merleau-Ponty M. Phenomenology of Perception. London, UK:
Conflicts of Interest and reported no conflicts of interest.
Routledge & Kegan Paul; 1945/1962.
20. Spiegelberg H. The Phenomenological Movement: A Historical
Ethics Approval Introduction. The Hague, The Netherlands: Martinus, Nijhoff;
1982.
This study was approved by the Ethical Review Authority, Sweden (Dnr: 21. Greenfield BH, Jensen GM. Understanding the lived experiences
2019:02750). of patients: application of a phenomenological approach to ethics.
Phys Ther. 2010;90:1185–1197.
22. Aspers P. Empirical phenomenology: a qualitative research
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